"Anatomical risk factors for intraoperative cerebrospinal fluid leaks in transsphenoidal surgery for pituitary adenomas".

"Anatomical risk factors for intraoperative cerebrospinal fluid leaks in transsphenoidal surgery for pituitary adenomas".

World Neurosurg. 2019 Jan 04;:

Authors: Campero A, Villalonga JF, Basso A

Abstract
BACKGROUND: Cerebrospinal fluid (CSF) fistulae are among the most clinically-important and frequent complications of transsphenoidal surgery for pituitary adenomas. Between the adenoma and the CSF, a "barrier" exists that consists of up to three elements which, from cephalad to caudad, are: the arachnoid, dura mater (sellar diaphragm), and pituitary glandular tissue. The objective of this study was to determine if the presence or absence of any of these three anatomical elements is associated with the development of an intraoperative CSF fistula.
METHODS: From November 2016 to June 2018, 40 patients with pituitary adenomas were operated upon, by transsphenoidal endonasal access, under a microscope. All surgeries were filmed in 3D. Intraoperative findings and preoperative magnetic resonance images (MRI) were analyzed and compared. Patients who developed a fistula were compared against those who did not.
RESULTS: In 20 patients, glandular tissue was identified between the tumor and subarachnoid space; in 13 dura mater was evident; and in seven, only arachnoid was noted. In six patients, an intraoperative CSF fistula occurred, all having arachnoid as the only barrier. The presence of a fistula was statistically more likely in patients with an arachnoid-only barrier than with any other barrier composition (p<0.001).
CONCLUSIONS: The anatomical architecture forming the roof of the pituitary fossa is an important determinant of intraoperative CSF fistula risk. When the barrier consists only of arachnoid, the risk is significantly higher than when not. Preoperative MRI is useful to determine the type of existing barrier.

PMID: 30615995 [PubMed - as supplied by publisher]

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